Mary Beth Gillis Johnson, MA, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.013522 Issued in IL

Practice address

405 N Wabash Ave Unit 4009
Chicago, IL 60611-5684

Phone

(312) 755-7000

NPI assigned

Apr 2, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wildwood Therapy LLC

  • Professional Counselor
  • Chicago, IL
  • NPI 1538825732
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1841878469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE UNIT 4009",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE UNIT 4009",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115684",
            "telephone_number": "312-755-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARY BETH",
        "middle_name": "GILLIS",
        "credential": "MA, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.013522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Shari Johnson
• Marilyn Sue Johnson, PH.D
• Markizh Johnson
• Marta L Johnson, LCSW
• Martha Petering Johnson, RN, APN.CNS, IBCLC
• Matthew Johnson, DPT, OCS, FAAOMPT
• Mattie C Johnson
• Maura Kathryn Johnson, RD
• Maya Johnson, DPT
• Meghan Johnson, LCSW

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.